[Evaluation of topical vasoconstrictors in pterygium surgery and their role in reducing intraoperative bleeding]. / Evaluación de vasoconstrictores tópicos en la cirugía del pterigión y su papel en la disminución del sangrado intraoperatorio.

OBJECTIVE: To reduce vascularisation before surgery through the application of topical vasoconstrictors, decreases the rate of intraoperative bleeding, improves the dynamics of the surgery and reduces the difficulty in surgical performance. METHODS: Only patients with primary pterygium were included in the study. A prospective randomized clinical trial was designed to compare intraoperative bleeding, need for cauterization and surgical time a group that was administered phenylephrine. preoperatively and one which did not receive it. The sample was divided into two groups: 1st (n=27) received topical phenylephrine (F) 0.1 ml (10%), twice in 5 minutes before surgery. 2nd (n=30) did not receive phenylephrine (NoF). The technique was similar in both groups using conjunctival autograft suturing. In both groups, the subconjunctival aneasthesia was performed with 0.5% bupivacaine hydrochloride with epinephrine 1:200,000. RESULTS: A total of 57 patients were included in the study. The mean operation time for group F was 15.57 minutes (SD: 1.8 min) and the NoF group 16.51 min (SD to 1.82 min, P=.057). In the group F, it was necessary to use diathermy in 2 patients (7.4%) and in the NoF group cauterisation was used in 14 patients (46.7%, Chi-Square=10.848, P=.001. There is a relative risk 6.3 (95% CI 1.57 - 25.27) times greater than having to cauterise without phenylephrine when used phenylephrine. CONCLUSIONS: The use of topical vasconstrictors prior to pterygium surgery reduces the rate of bleeding and the time of surgery.

Evaluación de vasoconstrictores tópicos en la cirugía del pterigión y su papel en la disminución del sangrado intraoperatorio / Evaluation of topical vasoconstrictors in pterygium surgery and their role in reducing intraoperative bleeding

Objetivo: Reducir la vascularización previa a la cirugía mediante la aplicación de vasoconstrictorestópicos disminuye la tasa de sangrado intraoperatorio, mejora la dinámica de lacirugía y reduce la dificultad de la actuación quirúrgicaMétodos: Sólo los pacientes con pterigión primario se incluyeron en el estudio. Un ensayoclínico aleatorizado prospectivo fue diseñado para comparar el sangrado intraoperatorio,necesidad de cauterización y tiempo de cirugía entre los grupos a los que se les administró ono fenilefrina preoperatoriamente. Lamuestra se dividió en dos grupos: 1◦ (n = 27) recibieronfenilefrina tópica (F) 0,1 ml (10%) por dos veces 5 minutos antes de la cirugía; 2◦ (n = 30) no seadministró fenilefrina (NoF). La técnica fue similar en ambos grupos, mediante autoinjertoconjuntival y sutura. En ambos, la anestesia subconjuntival se realiza con 0,5% de clorhidratode bupivacaína con epinefrina 1:200.000.Resultados: Un total de 57 pacientes se incluyeron en el estudio. Lamedia del tiempo quirúrgicopara el grupo F fue de 15,57 minutos (SD: 1,8 min) y para el grupo de NoF de 16,51 min(SD; 1,82 min; p = 0,057). En el grupo F, fue necesario usar la diatermia en 2 pacientes (7,4%),en el NoF se usó la cauterización en 14 pacientes (46,7%; Chi-cuadrado = 10,848; p = 0,001.Existe un riesgo relativo 6,3 (IC 95%: 1,57 a 25,27) veces mayor de tener que cauterizar sinfenilefrina que cuando se usa fenilefrina.Conclusiones: El uso de vasconstrictores tópicos previos a la cirugía de pterigión disminuyela tasa de sangrado y reduce el tiempo de cirugía(AU)

Objective: To reduce vascularisation before surgery through the application of topical vasoconstrictors,decreases the rate of intraoperative bleeding, improves the dynamics of thesurgery and reduces the difficulty in surgical performance.Methods: Only patients with primary pterygium were included in the study. A prospectiverandomized clinical trial was designed to compare intraoperative bleeding, need for cauterizationand surgical time a group thatwas administered phenylephrine. preoperatively andone which did not receive it. The sample was divided into two groups: 1st (n = 27) receivedtopical phenylephrine (F) 0.1 ml (10%), twice in 5 minutes before surgery. 2nd (n = 30) did notreceive phenylephrine (NoF). The technique was similar in both groups using conjunctivalautograft suturing. In both groups, the subconjunctival aneasthesia was performed with0.5% bupivacaine hydrochloride with epinephrine 1:200,000.Results: A total of 57 patients were included in the study. The mean operation time for groupF was 15.57 minutes (SD: 1.8 min) and the NoF group 16.51 min (SD to 1.82 min, P = .057). Inthe group F, it was necessary to use diathermy in 2 patients (7.4%) and in the NoF groupcauterisation was used in 14 patients (46.7%, Chi-Square = 10.848, P = .001. There is a relativerisk 6.3 (95% CI 1.57 - 25.27) times greater than having to cauterise without phenylephrinewhen used phenylephrine.Conclusions: The use of topical vasconstrictors prior to pterygium surgery reduces the rateof bleeding and the time of surgery(AU)

[Intraocular phakic lens ZSAL-4 for high myopia correction]. / Lente ZSAL-4 para la corrección de la alta miopía.

PURPOSE: To evaluate the effectiveness, safety and predictability of the phakic intraocular lens (IOL) ZSAL-4 for correction of high myopia. METHODS: In this retrospective study 28 IOL in 19 patientes were implanted. The following data were recorded, preoperatively, one week, one month, 3, 6 and 12 months postoperatively: spherical equivalent (SE), astigmatism, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), endothelial cell density (CD), coefficient of variation (CV) and intraocular pressure (IOP). We performed LASIK in 3 eyes to correct a residual refractive defect. RESULTS: The mean age was 29.7 S.D. 5.77 years and the mean following 7.62 S.D. 7.29 months. Six months postoperatively, the preoperative SE of -14.91 S.D. 2.88 was reduced to -1.29 S.D. 0.53; the BCVA varied from 0.56 S.D. 0.16 to 0.58 S.D. 0.12; the CD changed from 2670 S.D. 252 cells/mm2 to 2344 S.D. 262. The CV showed stability. The UCVA six months postoperatively was 0.39 S.D. 0.15. No eyes lost any line of BCVA; during the first month 63% of the eyes won 2 or more lines. The efficacy index was 0.83 S.D. 0.24 one month postoperatively and 0.63 S.D. 0.32 one year postoperatively; the safety index was 1.44 D.S. 0.34 and 1.30 S.D. 0.35 respectively. One IOL was explanted the second day due to pupilary blockage; 7 eyes had transient high IOP; 2 eyes developed pupilary ovalization and in 4 cases the IOL suffered some degree of rotation. One eye presented a flat retinal detachment one year postoperatively but with no other complications. The 3 eyes submitted to LASIK presented 0.8 of BCVA the third month after LASIK. CONCLUSIONS: ZSAL-4 IOL implantation is an effective and safe procedure with an acceptable predictability which, in some cases, could be improved with LASIK.

Lente zsal-4 para la corrección de la alta miopía / Intraocular phakic lens zal-4 for high myopia correction

Objetivo: Estudiar la eficacia, seguridad y predictibilidad del implante de lente ZSAL-4 para la corrección quirúrgica de la alta miopía. Método: Estudiamos retrospectivamente 28 ojos de 19 pacientes en los que se implantó una lente ZSAL-4. Los datos recogidos preoperatoriamente y a la semana, mes, 3, 6 y 12 meses fueron: equivalente esférico (EE), astigmatismo, agudeza visual sin corrección (MAVSC), agudeza visual con corrección (MAVCC), densidad celular (DC), coeficiente de variación (CV), presión intraocular (PIO). En 3 ojos se realizó LASIK para corregir un defecto refractivo residual. Resultados: La edad media fue de 29,7 D.E. 5,88 años y el seguimiento medio de 7,62 D.E. 7,29 meses. A los 6 meses el EE preoperatorio (-14,91; D.E. 2,88) bajó a (-1,29; D.E. 0,53); la MAVCC pasó de 0,56 D.E. 0,16 a 0,58 D.E. 0,12; la DC varió de 2670 D.E. 252 células/mm2 hasta 2344 D.E. 262. El CV se mantuvo estable. La MAVSC a los 6 meses era 0,39 D.E. 0,15. Ningún ojo perdió líneas de MAVCC; un 63 por ciento ganó dos o más el primer mes. El índice de eficacia fue 0,83 D.E. 0,24 al mes y 0,63 D.E. 0,32 al año; el índice de seguridad, 1,44 D.E. 0,34 y 1,30 D.E. 0,35 respectivamente. Explantamos una lente el 2.º día por bloqueo pupilar, 7 ojos registraron hipertensión ocular transitoria, en 2 tenemos ovalización pupilar, y en 4 la lente ha rotado mínimamente. Hemos visto un desprendimiento de retina plano al año sin trascendencia clínica. En los que se realizó LASIK la MAVSC fue 0,8 el 3.er mes. Conclusiones: Implantar una ZSAL-4 es un procedimiento eficaz y seguro, con una predictibilidad aceptable que puede mejorarse de forma segura con técnica LASIK (AU)

Purpose: To evaluate the effectiveness, safety and predictability of the phakic intraocular lens (IOL) ZSAL-4 for correction of high myopia. Methods: In this retrospective study 28 IOL in 19 patientes were implanted. The following data were recorded, preoperatively, one week, one month, 3, 6 and 12 months postoperatively: spherical equivalent (SE), astigmatism, uncorrected visual acuity (UCVA), best corrected visual acuity (BCVA), endothelial cell density (CD), coefficient of variation (CV) and intraocular pressure (IOP). We performed LASIK in 3 eyes to correct a residual refractive defect. Results: The mean age was 29.7 S.D. 5.77 years and the mean following 7.62 S.D. 7.29 months. Six months postoperatively, the preoperative SE of -14.91 S.D. 2.88 was reduced to -1.29 S.D. 0.53; the BCVA varied from 0.56 S.D. 0.16 to 0.58 S.D. 0.12; the CD changed from 2670 S.D. 252 cells/mm2 to 2344 S.D. 262. The CV showed stability. The UCVA six months postoperatively was 0.39 S.D. 0.15. No eyes lost any line of BCVA; during the first month 63% of the eyes won 2 or more lines. The efficacy index was 0.83 S.D. 0.24 one month postoperatively and 0.63 S.D. 0.32 one year postoperatively; the safety index was 1.44 D.S. 0.34 and 1.30 S.D. 0.35 respectively. One IOL was explanted the second day due to pupilary blockage; 7 eyes had transient high IOP; 2 eyes developed pupilary ovalization and in 4 cases the IOL suffered some degree of rotation. One eye presented a flat retinal detachment one year postoperatively but with no other complications. The 3 eyes submitted to LASIK presented 0.8 of BCVA the third month after LASIK. Conclusions: ZSAL-4 IOL implantation is an effective and safe procedure with an acceptable predictability which, in some cases, could be improved with LASIK (Arch Soc Esp Oftalmol 2002; 77: 661-668) (AU)